This systematic review pooled 26 retrospective cohorts involving 4,890 patients with fulminant myocarditis to examine associations with all-cause in-hospital mortality. Cardiac arrest or CPR was associated with higher mortality odds (OR 2.57, 95% CI 1.49–4.44), while LVEF was inversely associated (OR 0.94, 95% CI 0.90–0.97). Age, lactate and cTnI also showed positive associations, while intravenous immunoglobulin therapy showed an inverse association. Evidence certainty was low for age and cTnI and very low for the other significant factors; lactate and immunoglobulin estimates were unstable in sensitivity analyses.
These findings identify potential prognostic markers in fulminant myocarditis, but do not establish causality or treatment benefit. The immunoglobulin association is particularly fragile.
Study limitation: All included cohorts were retrospective, and most significant associations had very-low-certainty evidence.
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